Liver Transplantation

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Liver Transplantation | cirrhosis is one of the most common causes of end-stage liver disease, which is called chronic and occurs when...

What is a liver transplant? Causes and conditions of liver transplantation

The liver is the largest internal organ in the body that stores the required energy and eliminates toxins. Without the liver, you can not live! If the liver fails, your doctor may put you on a waiting list for a liver transplantation. Doctors will transplant the liver if the person is unable to continue working with the damaged liver despite other treatments. During a liver transplantation, the surgeon removes the patient’s liver and replaces it with a healthy one. Most of the transplantation come from a deceased donor, but sometimes there will be a living donor. This is when a healthy person donates part of his/her liver to a specific patient.

What is a liver transplantation?

Liver transplantation is surgery to replace a patient’s liver with a healthy one from another person. In most cases, a healthy liver is obtained from a donor who has just died, or sometimes a living person donates part of his or her liver. The living donor may be a family member or a person who is not related to the sick person but whose blood type matches him or her.
People who donate part of their liver can live a healthy life with the remaining liver. The liver is the only organ in the body that can regenerate itself and regenerate lost or damaged tissue. The donor liver will soon return to normal size after surgery. The part that is received as the new liver also grows to its normal size within a few weeks.

Cause of liver transplantation

People cannot live without the liver. If the liver is not working properly, a transplant may be needed. In the last stage of liver disease (chronic liver failure), liver transplantation is recommended. Chronic liver failure is a serious and life-threatening disease.
Cirrhosis is one of the most common causes of end-stage liver disease, which is called chronic and occurs when healthy liver tissue is replaced by scar tissue; This causes the liver to not function properly.
Other diseases that may lead to the final stage of liver disease include:
Acute liver necrosis: This is when the tissue in the liver dies. Possible causes include acute infection and reaction to drugs or toxins.
Bile atresia: A rare disease of the liver and bile ducts that occurs in newborns.
Viral hepatitis: Hepatitis B or C is a common cause.
Metabolic diseases: Irregularities that alter the chemical activity of cells affected by the liver.
Primary liver cancers: These cancerous tumors start in the liver.
Autoimmune hepatitis: Redness or swelling of the liver. This happens when the body’s immune system (the immune system) attacks the liver.

Risk factors for liver transplantation

• Bleeding
• Infection
Obstruction of blood vessels in the new liver
• Bile leakage or blocked bile ducts
The new liver does not work for a short time immediately after surgery.
The new liver may also be rejected by the body’s immune system. Rejection is the body’s natural response to a foreign object or tissue. When a new liver is transplanted into the body, the immune system thinks it is a threat and attacks it.
To help the new liver in the body, you must use anti-rejection drugs (drugs that suppress the immune system). These drugs weaken the immune system’s response. You should take these medications for the rest of your life. Some liver diseases can come back after a transplant. To help with transplant success, if you have these conditions, start with hepatitis B or C medications early.

Signs and symptoms of liver transplantation

Gastrointestinal bleeding: The more the liver is injured, the greater the resistance to portal blood flow, leading to increased pressure in the portal venous system. This portal blood pressure necessitates alternative pathways for blood to return to the heart. Small veins throughout the abdomen, but outside the liver, then enlarge and their walls become thinner because an abnormal amount of blood flows through them under high pressure. These fragile veins, called varicose veins, often cover parts of the gastrointestinal tract, especially the esophagus and stomach, and are prone to rupture and bleeding. When bleeding occurs in the intestinal tract, it can be life threatening.
Fluid retention: One of the functions of the liver is to synthesize many circulating proteins, including albumin. Albumin and other proteins in the bloodstream retain fluids in the vascular space by exerting what are known as osmotic pressure. In liver failure, low levels of albumin expel fluids from the bloodstream, which cannot be reabsorbed.
Therefore, fluids accumulate in the tissues and cavities of the body, usually in the abdominal cavity, which is called abdominal dehydration. Fluids can also collect in the legs (peripheral swelling or pedals) or in the chest cavity (hydrothorax). Fluid retention, first with severe restriction of salt intake in the diet, second with the use of drugs (diuretics) that increase salt and water loss through the kidneys, and finally, with intermittent drainage by placing a needle in the abdominal cavity or The chest is treated.
Encephalopathy: Failure to clear ammonia and other toxins from the blood in the liver causes these substances to accumulate. These toxins lead to cognitive dysfunction, ranging from a disturbed pattern of sleep-wake disorder to mild confusion and coma.
Jaundice: One of the main functions of the liver is to break down the breakdown products of hemoglobin, a molecule that carries oxygen in our blood. Bilirubin is one of those destructive products that is processed and excreted by the liver. In liver failure, bilirubin is not cleared from the body and the level of bilirubin in the blood increases. Then the skin and all the tissues of the body turn yellow.

Diagnosis of liver transplantation

If the health care provider thinks that the person in question may be a good candidate for a liver transplant, he or she will refer the person to a transplant center for evaluation. Transplant centers are located in special hospitals. He will perform various tests by the transplant center team. They will decide whether to put his name on the national transplant waiting list. The transplant center team consists of the following groups:
• A transplant surgeon
• A liver transplant specialist (liver specialist)
• Transplant nurses
• A social worker
• Psychiatrist or psychologist
• Other team members such as a nutritionist or anesthesiologist
The process of evaluating a liver transplantation includes the following:
Psychological and social evaluation: Many different topics are evaluated. These include stress, financial worries, and whether or not you will support your family or friends after surgery.
Blood tests: These tests are done to help find a good match and evaluate his or her priority on the waiting list. They can also help improve the chances of the body rejecting the donor liver.
Diagnostic tests: Tests may be done to check a person’s liver and general health. These tests may include x-rays, ultrasounds, liver biopsies, heart and lung tests, colonoscopies, and dental examinations. Women may also have a Pap test, gynecological examination, and mammogram..

The transplant center team checks all of a person’s information. At each transplant center, there are rules for people who can have a liver transplant. This liver transplantation may not be possible if the following conditions are present:
• Have an ongoing or chronic infection that cannot be treated.
Have metastatic cancer. It is a cancer that has spread from its original location to one or more other parts of the body.
Have severe heart problems or other health problems.
In addition to liver disease, you also have a serious illness that will not get better after the transplant.
• Unable to follow a treatment plan.
• Drink too much alcohol.

Being on the waiting list

If you are accepted as a transplantation candidate, your name will be placed on the national transplantation waiting list. People who are in dire need of a new liver are at the top of the list. Many people have to wait a long time for a new liver. The person will be notified when a member is available. You must go to the hospital immediately to prepare for the operation.
If a living person donates part of his/her liver to a sick person, surgery is planned in advance.patient and the donor will have surgery at the same time. The donor must be in good health and have a blood type that matches the patient. The donor will also perform a psychological test. This is to ensure his comfort in this decision.

How can we prepare for a liver transplantation?

The treatment provider explains the procedure to the patient. The patient is asked questions about surgery.
He or she may be asked to sign a consent form authorizing the hospital to perform the surgery. The patient should read the form carefully and ask their questions.
In the case of a planned transplantation, the patient should not eat for eight hours before surgery. This often means not eating or drinking after midnight. If the liver is from a donor who has just died, the patient should no longer eat or drink as soon as the liver is known.
A sedative may be given to the patient before surgery to help relax. The health care provider may provide other instructions depending on the patient’s medical condition.

What happens during a liver transplant?

Liver transplant surgery requires a hospital stay. Methods may vary depending on the condition of the person receiving the liver and the function of the donor. In general, liver transplantation follows the following process:
• The person is asked to take off their clothes and put on special clothes.
The intravenous tube is inserted into the arm or hand. Other tubes are placed in the neck and wrists or may be placed under the collarbone or in the area between the abdomen and thighs (groin). These are used to check the heart and blood pressure and to take blood samples.
• Back to the operating table.
• If there is a lot of hair at the surgery site, it will be shortened.
A catheter is inserted into the bladder to drain urine.
After anesthesia, the anesthetist inserts a tube into a person’s lungs. This is because he can be helped to breathe with a device (breathing apparatus). An anesthesiologist will monitor your heart rate, blood pressure, respiration and blood oxygen levels during surgery.
• The skin above the surgical site is cleaned with a sterile solution (disinfectant).
The doctor makes an incision just below the ribs on either side of the abdomen. This incision extends directly upwards at a short distance from the breast bone.
The doctor carefully separates the patient’s liver from adjacent organs and structures.
The connected arteries and veins are tightly closed to prevent blood flow to the patient’s liver.
• Different surgical methods can be used to remove the patient’s liver and implant the donor liver.
• The patient’s liver is removed from the blood vessels after cutting.
• The surgeon examines the donor’s liver before transplanting.
The donor liver attaches to the blood vessels. Blood flow to the new liver begins. The surgeon examines the bleeding for sutures.
The new liver attaches to the bile ducts.
• The incision will be closed with sutures or surgical staples.
• A drain may be placed at the incision site to reduce swelling and collect fluid.
• Sterile dressing will be applied after suturing.

What happens after a liver transplantation?

After surgery, you may be transferred to the recovery room a few hours before being transferred to the intensive care unit (ICU). You will be closely monitored in the ICU for several days.
Monitors show heart rate, blood pressure, respiration rate and oxygen level. You should stay in the hospital for 1 to 2 weeks or more.
You will most likely have a tube in your throat. This is because you can breathe with the help of a device (breathing apparatus) until you can breathe naturally. Depending on your condition, you may need a breathing tube for hours or days.
They may insert a thin plastic tube through the nose into the stomach to remove swallowed air. When the bowels start working normally again, the tube comes out. You cannot eat or drink until the tube is removed.
Blood samples are often taken to check for new liver. They also check that the kidneys, lungs and circulatory system are working properly.
You may be taking antibiotics. Once the airway and stomach tubes have been removed and stabilized, you may start eating fluids and slowly start eating solid foods. The transplant team teaches the individual how to take care of themselves when they return home.

Home care

When you are at home, you should keep the surgical site clean and dry. The service provider gives specific instructions for bathing. If the stitches or surgical staples are not removed before leaving the hospital, they will be removed for an office visit.
Contact your healthcare provider if you have any of the following:
•Fever: This may be a sign of rejection or infection.
Redness, swelling, or other bleeding or discharge from the incision
• More pain around the incision site:This may be a sign of infection or rejection.
• Vomiting or diarrhea
• Bleeding
Jaundice (jaundice of the skin and eyes)

What should be done to prevent liver rejection?

You should take medicine for the rest of your life to keep your transplanted liver healthy. These drugs are called immunosuppressive drugs. They weaken the immune system’s response. Each person may respond differently to medications, and each transplant team prefers different medications.
These new drugs are always made and approved. The doctor will create the right medication plan for the person. In most cases, you take some anti-rejection drugs first. Doses often vary depending on how the person responds to them.
Because anti-rejection drugs affect the immune system, people who have a liver transplant are at higher risk for infection. Some of the higher risk infections are:
• Oral yeast infection (thrush)
• Herpes
• Respiratory viruses
During the first few months after surgery, you should avoid contact with the population or anyone with the infection. Each person may have different symptoms of liver rejection. Some common symptoms of liver failure include:
• Fever
• Jaundice of the skin and eyes (jaundice)
Dark urine
• Itching
Swollen or painful abdomen
Feeling very tired
• Headache
• Upset stomach
Rejection symptoms can be as common as any other health problem. Talk to your link team about any concerns. It is important to see them and talk to them often.

Outlook for liver transplant patients

Living with a liver transplant is a lifelong process. Drugs should be given to deceive the immune system so that it does not attack the transplanted organ. Other medications should be prescribed to prevent the side effects of anti-rejection drugs such as infection. Repeated doctor’s visits are essential.

kindly if you are candidate of liver transplantation , don’t be hesitate ask of IR4T experts to help you for procedures of liver transplantation in Iran and turkey.

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